11.2 CPR/AED/BLS/ACLS, Universal Precautions & EMS Activation

ACSM Certified Clinical Exercise Physiologist ACSM-CEP

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1 Introduction & Exam Overview

1.1 The ACSM-CEP Role, Job Definition & Scope of Practice 1.2 Exam Format, Domain Weights & Scoring 1.3 Eligibility, Study Planning & Test-Day Strategy

2 Applied Exercise Physiology & Metabolic Calculations

Bioenergetics & Energy Systems (ATP-PC, glycolytic, oxidative) Acute Cardiorespiratory & Metabolic Responses to Aerobic Exercise Responses to Resistance Exercise & Chronic Training Adaptations ACSM Metabolic Equations, METs & Interpreting VO₂ / RER / Ventilatory Threshold

3 Pathophysiology of Clinical Populations

3.1 Coronary Artery Disease, Myocardial Infarction & Revascularization (PCI/CABG) 3.2 Heart Failure, Valvular Disease & Cardiac Rhythm Disorders 3.3 Hypertension, Dyslipidemia & Peripheral Artery Disease 3.4 Pulmonary Disease: COPD, Asthma & Restrictive/Interstitial Disorders 3.5 Diabetes, Metabolic Syndrome & Obesity 3.6 Renal Disease & Musculoskeletal/Orthopedic Conditions 3.7 Neuromuscular, Neurological & Cognitive Conditions (stroke, MS, Parkinson's, SCI) 3.8 Neoplastic, Immunologic & Hematologic Disorders (cancer, HIV/AIDS, anemia)

4 Clinical ECG Interpretation

4.1 ECG Leads, Waveforms, Rate & Rhythm Determination 4.2 Arrhythmias & Conduction Blocks 4.3 Ischemia, Injury & Infarction (ST changes, exercise-induced) 4.4 Drug & Electrolyte ECG Effects; Resting/Exercise Monitoring Setup & Lead Placement

5 Pharmacology for the Clinical Exercise Physiologist

5.1 Beta-Blockers, Calcium-Channel Blockers & Nitrates 5.2 RAAS Agents, Diuretics, Antiarrhythmics, Lipid-Lowering & Antithrombotic Drugs 5.3 Bronchodilators, Corticosteroids, Insulin & Oral Antidiabetic Agents 5.4 Medication Effects on HR/BP & Exercise Response; Dose/Meal/Dialysis Timing

6 Patient Assessment (Domain I, 18%)

6.1 Medical Records, HIPAA/HITRUST, Charting & Physician Referral 6.2 Patient Interview, Medical History & Medication Reconciliation 6.3 Resting Vital Signs, Body Composition & Resting ECG 6.4 Preparticipation Health Screening & Level of Monitoring (PAR-Q+, ACSM algorithm, ACC/AHA · GOLD · ADA · AACVPR) 6.5 Assessing Patient Goals, Readiness & Psychosocial Status

7 Clinical Exercise Testing (Domain II, 18%)

Submaximal Aerobic Tests (treadmill, cycle, step, 6-minute walk) Musculoskeletal Fitness, Mobility & Balance Testing Maximal Symptom-Limited GXT: Protocols, Contraindications & ECG Prep Test Termination: Relative & Absolute Indications Interpreting & Reporting Results (ECG response, RPP, claudication, Duke Treadmill Score, VO₂/RER/AT)

8 Exercise Prescription for Clinical Populations (Domain III, 22%)

FITT-VP Principles, Progression & Prescription Foundations Ex Rx for Cardiovascular Disease (CAD, HF, HTN, PAD, post-revascularization) Ex Rx for Pulmonary Disease (COPD, asthma; breathing techniques, supplemental O2) Ex Rx for Diabetes, Metabolic Syndrome & Obesity Ex Rx for Musculoskeletal, Neuromuscular, Neoplastic & Other Conditions Communicating Intensity (THR, RPE, talk test), Monitoring & Modifying the Prescription

9 Exercise Training & Leadership (Domain IV, 24%)

9.1 Discussing the Training Plan, Clinician & Patient Expectations/Goals 9.2 Instructing & Modifying Exercise Modes (cardiorespiratory, strength/endurance, flexibility, coordination, agility) 9.3 Patient Monitoring & Supervision During Exercise (telemetry, oximetry, glucometry, ECG) 9.4 Contraindications to Training & Modifying Recommendations 9.5 Documenting Clinical Status, Reporting Adverse Events & Interdisciplinary Coordination

10 Education & Behavior Change (Domain V, 13%)

10.1 Behavioral-Health Screening & Recognizing Distress (PHQ-9, Beck, SF-36; referral) 10.2 Patient Education, Health Literacy & Disease Self-Management 10.3 Motivational Interviewing & Behavior-Change Theories (Transtheoretical, HBM, Social Cognitive, Five-A's) 10.4 Promoting Adherence, Self-Efficacy, Relapse Prevention & Social Support

11 Legal, Professional & Emergency Management (Domain VI, 5%)

11.1 Emergency Equipment, Crash Cart Inspection & Emergency Procedures 11.2 CPR/AED/BLS/ACLS, Universal Precautions & EMS Activation 11.3 Scope of Practice, Legal/Ethical Standards, Liability/Negligence, Informed Consent & Professional Organizations (ACSM/AACVPR/AHA)

11.2 CPR/AED/BLS/ACLS, Universal Precautions & EMS Activation

Key Takeaways Explain This Topic AI

The AHA Chain of Survival's first three links — recognition/EMS activation, early high-quality CPR, and early defibrillation — occur within the CEP's own facility and control.

High-quality adult CPR is 100-120 compressions/min at a depth of 2-2.4 inches, with a 30:2 compression-to-ventilation ratio for a single rescuer without an advanced airway.

Recognizing exercise emergencies quickly is essential: agonal gasps signal cardiac arrest, blood glucose below 70 mg/dL with symptoms is treated with the 15-15 rule, and a core temperature above 104°F with CNS dysfunction is exertional heat stroke requiring immediate cooling.

All CEPs must hold current BLS certification; AACVPR-certified and other medically supervised clinical programs typically require at least one ACLS-certified staff member on-site.

OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) requires universal precautions treating all blood/body fluids as potentially infectious, with gloves, sharps disposal, and a written exposure control plan.

Last updated: July 2026

CPR/AED/BLS/ACLS, Universal Precautions & EMS Activation

Quick Answer: Recognizing an exercise emergency and responding correctly in the first seconds — starting CPR, applying an AED, treating hypoglycemia with the 15-15 rule, or cooling exertional heat stroke — determines survival. Every CEP must maintain current BLS/CPR-AED certification (compressions at 100-120/min, depth 2-2.4 in, ratio 30:2), follow universal precautions under OSHA's bloodborne-pathogens standard, and know exactly how and when to activate EMS.

A clinical exercise physiologist works with patients who carry elevated cardiovascular, metabolic, and pulmonary risk by definition — recognizing and responding to an emergency in the first seconds is a core, testable Domain VI competency.

The Chain of Survival

The AHA's out-of-hospital adult Chain of Survival sequences the actions that determine whether a patient survives cardiac arrest: (1) early recognition and activation of EMS, (2) early high-quality CPR, (3) early defibrillation, (4) basic and advanced EMS care, (5) advanced life support and post-cardiac-arrest care, and (6) recovery. The first three links happen inside a CEP's own facility and are directly within a CEP's control — which is why speed and quality in those first minutes matter more than any other single factor.

Recognizing Common Exercise Emergencies

Condition Key Signs Immediate CEP Action

Sudden cardiac arrest Unresponsive, no normal breathing (agonal gasps are not normal breathing), no pulse Activate EMS, begin CPR immediately, apply the AED as soon as it arrives

Acute MI / angina Chest pain, pressure, or tightness, possibly radiating to arm/jaw/back; dyspnea, diaphoresis, nausea Stop exercise, activate the EAP/EMS, keep the patient in a position of comfort, do not leave them alone

Hypoglycemia Confusion, shakiness, sweating, weakness; blood glucose below 70 mg/dL If conscious and able to swallow safely, give 15 g fast-acting carbohydrate and recheck glucose in 15 minutes (the 15-15 rule ), repeating if still low; if unresponsive, activate EMS

Exertional heat stroke Core temperature above 104°F (40°C) plus central nervous system dysfunction (confusion, seizure, coma) — the patient may still be sweating Activate EMS, cool first and transport second; cold-water immersion is the fastest method when available, otherwise remove excess clothing and apply ice/cold packs to the neck, axillae, and groin

Exertional syncope Sudden, brief loss of consciousness during or immediately after exertion Stop exercise, protect from fall injury; syncope occurring during exertion (rather than immediately after, which is more often benign post-exercise pooling) raises concern for a serious underlying cardiac cause and requires medical evaluation before the patient resumes exercise

Symptomatic arrhythmia Irregular, unusually fast, or unusually slow pulse with dizziness, palpitations, or near-syncope Stop exercise/testing immediately, monitor vital signs, and notify the supervising physician

Exertional hypotension Systolic BP fails to rise, or drops 10 mmHg or more, with increasing workload Terminate the test/exercise session (this is a recognized termination indication) and monitor recovery

BLS: The CEP's Baseline Skill

Every CEP must maintain current CPR/AED certification at the Basic Life Support (BLS) for Healthcare Providers level . High-quality adult CPR means chest compressions delivered at 100-120 per minute , to a depth of 2-2.4 inches (5-6 cm) , allowing full chest recoil between compressions and minimizing interruptions to under 10 seconds. For a single rescuer without an advanced airway in place, the compression-to-ventilation ratio is 30:2 . The AED should be applied the moment it is available; the rescuer follows its voice prompts, delivers a shock if advised, and resumes compressions immediately afterward.

ACLS in Medically Supervised Settings

Advanced Cardiac Life Support (ACLS) builds on BLS with cardiac rhythm interpretation, defibrillation protocols, IV/IO access, emergency cardiovascular medications, and advanced airway management. Because AACVPR-certified cardiac and pulmonary rehabilitation programs (and other medically supervised clinical exercise settings) serve patients with a materially higher baseline cardiac risk, standard practice is to have at least one ACLS-certified staff member on-site whenever patients are being tested or trained, in addition to universal BLS certification for all staff.

Universal Precautions & Bloodborne Pathogen Exposure Control

Under OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) , all blood and certain body fluids are treated as potentially infectious for HIV, hepatitis B, and other bloodborne pathogens, regardless of the source. This means wearing gloves for any contact with blood or body fluids, following the facility's written exposure control plan, using proper sharps disposal, and completing required post-exposure evaluation and follow-up if an exposure occurs.

Activating EMS

For cardiac arrest, chest pain concerning for MI, altered mental status, or any life-threatening presentation, EMS (911 or the local equivalent) is activated immediately — a lone rescuer with a phone puts it on speaker rather than delaying compressions to make the call. The call must include the exact facility location and access instructions, and a staff member should be assigned to meet EMS at the entrance and guide them directly to the patient. CPR and AED use continue without interruption until EMS personnel arrive and formally assume care.